BATHURST CBD/ SUBURBS Internet Order Please complete this order form and our accounts team will be in contact to arrange your install. This form does not guarantee that our service is available at your address, this will be confirmed by our technician prior to your install. If you wish to change the details of your selected plan please call to speak to our accounts team prior to your installation date. Before you complete the order please read the Terms and Conditions and the Critical Information Summary below. Critical Information Summary Customer Relationship Agreement Standard Form of Agreement Real estate permission template First Name * Last Name * Business Name DOB * Service Address * Suburb * Postcode * Preferred Contact Number * Alternate Phone Number Email Address * Confirm Email address * ______________________________________ Would you like to add another person who can access your account? Authorised Account Contact Authorised contact phone number Authorised contact DOB Authority levelLimited - enquire / discuss onlyFull authority to act on my behalf ______________________________________ Selected Plan *---VALUE: $49.95pm (unlimited data, 50mbps down / 20mbps up)SPEED+ : $69.95pm (unlimited data, 100mbps down / 20mbps up)BUSINESS 1: (unlimited data, 100mbps down / 20mbps up, plus 4G backup) - must choose business routerDISCUSS A CUSTOM PLAN: Thank you for your application, our team will be in touch to discuss your needs Wireless equipment - A standard installation does NOT include a wireless router or modem. *---I am unsure what is suitable and would like to discuss a new modem at the installI only need basic Wi-Fi (Units and very low use/short distance) $99I need standard Wi-Fi (normal use, average house size) $149*4G business plan - $249I need strong Wi-Fi - QUOTE REQUIREDI would like to check if I can use the modem from my previous provider (Please see note below) NOTE- * I understand that a $50.00 service fee may apply where my existing equipment requires more than basic setup.* While the technician will make reasonable efforts to use existing equipment, CWNet cannot guarantee compatibility with their network due to possible restrictions from your previous provider.* I understand that CWNet cannot provide a warranty on equipment they did not supply.* I understand that if my existing equipment is not compatible, I may purchase suitable equipment from CWNet or another retailer. Wi-Fi setup of TV's etc *---I am happy to setup my own Wi-FiI would like to add Wi-Fi setup to my installation ($99 per hour) Do you currently have an active internet connection. *---YES, I have an active plan with another providerNO, I currently have no internet access Do you have a home phone/land line that you would like to keep? *---YES - I would like to transfer my current phone number (we will be in touch to discuss)NO - I do not have a number that I want to transfer ______________________________________ Contract 1 - I will read and understand and accept the terms and conditions set out in the current version of the "Customer Relationship Agreement" and "Standard Form of Agreement" as linked above and via https://www.cwnet.com.au/tc/ *YesNo Contract 2 - I agree to the above nominated plan for the minimum term of 1 month and understand that this is to be paid within 5 days of my service being activated. *YesNo Contract 3 - I understand I will require to provide ID and Signatures on the day of the installation *YesNo Contract 4 - I am the owner of the property, or have permission from the owner of the property, for a wall plate to be installed on internal wall of the building, and a mount and small dish to be installed on the roof of the building *YesNo Contract 5 - I agree to CWNet contacting me on the email and phone number provided above for the purposes of implementing and maintaining my account, general announcements and occasional promotions *YesNo ______________________________________ Word of mouth (please give their name so that we can thank them!) *Social Media (FB/Insta)Print advertising (Flyer)Sign around townRadioWord of mouth Additional comments or questions Submit Standard Form of Agreement Customer Relationship Agreement Critical Information Summary Real estate permission template
